title: EMR versus gastrectomy for intramucosal gastric cancer: comparison of long-term outcomes.
abstract: BACKGROUND
  Limited data exist regarding the long-term outcomes of EMR compared with gastrectomy.
  
  
  OBJECTIVE
  To compare the long-term outcomes after EMR and surgery.
  
  
  METHODS
  Retrospective analysis with propensity-score matching.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  This study involved 215 patients with intramucosal gastric cancer completely removed by EMR and 843 patients who underwent curative surgical resection between January 1997 and August 2002. Propensity-score matching yielded 551 matched patients.
  
  
  METHODS
  EMR versus surgery.
  
  
  METHODS
  Death and recurrence.
  
  
  RESULTS
  In the matched cohort, there were no significant between-group differences in the risk of death (hazard ratio [HR] for the EMR group 1.39; 95% CI, 0.87-2.23) or recurrence (HR 1.18; 95% CI, 0.22-6.35). Although patients who underwent EMR had higher risk of metachronous gastric cancers (HR 6.72; 95% CI, 2.00-22.58), all recurrent or metachronous gastric cancers after EMR were successfully re-treated without affecting overall survival. Although complication rates were similar (odds ratio 0.84; 95% CI, 0.41-1.70), there were no mortalities in the EMR group compared with 2 in the surgery group. The EMR group had a significantly shorter hospital stay (median 8 days, interquartile range [IQR] 6-11 days vs 15 days, IQR 12-19 days; P<.001) and lower cost of care ($2049, IQR $1586-2425 vs $4042, IQR $3458-4959; P<.001).
  
  
  CONCLUSIONS
  Retrospective, nonrandomized study.
  
  
  CONCLUSIONS
  EMR was comparable to surgery in terms of risk of death and recurrence. Because of its lower medical costs and shorter duration of hospital stay, EMR has advantages over surgery.
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Kwi-Sook
authors.initials: KS
authors.lastname: Choi
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.forename: Ho June
authors.initials: HJ
authors.lastname: Song
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Kim
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Byung Sik
authors.initials: BS
authors.lastname: Kim
authors.forename: Sung Tae
authors.initials: ST
authors.lastname: Oh
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Yook
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Jang
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Seon Ok
authors.initials: SO
authors.lastname: Kim
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods*; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome